Name: _________________________________________

Address:_______________________________________

City:__________________________________________

State, Zip (Country):_____________________________

Phone:________________________________________

E-Mail Address:___________________________________

CC&GTCC Membership Number:_____________________

Areas of Interest:________________________________
 

I would like you to publish my.......

___Name & Address

___Phone Number

___Do NOT Publish My Name, Address or Phone Number

Mail completed application with your first year dues of $10.00 and a one time new member processing fee of $5.00.

Associate membership for your spouse is available for an additional $10.00.

Amount Enclosed ($___________ )

Send check made payable to Silver Strikers Club to:
 

Sponsored By: Andy Hughes LM-2471-52  SS-385